It is necessary, during an intervention on an artery, even as benign as a puncture or cannulation, to suture the wounded membrane, or even to affix a patch, as described in U.S. Pat. No. 3,988,782.
A still increasing use is made in medicine and in surgery of instruments which are introduced via the blood system. Several devices were thus developed for closing a blood vessel with a clip after a percutaneous puncturing.
US-2002/0082641 describes a method and a device for fitting a flat-shaped vascular clip corresponding roughly to the preamble of claim 1. However, this clip causes accentuated deformation (swelling) of the wall to be sutured and is relatively aggressive to install. Similar devices are known by US 2002/002386 and US 2002/082641. They describe in every case quite bulky percutaneous devices, which are put in place after the puncturing proper, the latter being performed with a cutting instrument like a lancet. These devices are generally used (like US 2002/002386) for introducing a catheter. Using such devices implies applying non-neglectible promptings on the surrounding tissues. After the removal of the device introduced in the blood stream, the fitting of the clip itself, even when made carefully, will shake the vessel as well as the surrounding tissues.
Heart surgery often requires the heart to be shut down so as to obtain a stationary and bloodless operating site allowing precise and delicate surgical handwork. This requires the use of extracorporeal circulation (ECC) so as to perfuse the systemic organs (brain, liver, kidneys, etc.) with oxygenated blood during the period when the heart is shut down.
To do this, the aorta has to be clamped, this operation usually consisting in closing off the vessel by an external clamp that is interposed between the arterial cannula allowing extracorporeal circulation and the orifice of the coronary arteries. This procedure isolates the coronary circulation from the blood flow provided by the ECC and therefore allows the heart to be shut down.
Injection of a solution into the network of coronary arteries (cardioplegia) protects the heart itself during the shutdown period.
Installing the extracorporeal circulation (ECC) system, the clamping and the cardioplegia conventionally require the sternum to be cut open and splayed (sternotomy). Sternotomy is firstly a destructive surgical procedure that frequently poses postoperative complications for the patient.
In recent years, alternative techniques have been developed for heart surgery with the aim of being less aggressive for the patient. The exclusion of sternotomy is one of these approaches. In this case, the invention is carried out by mini-incisions that allow endoscopic instruments to be introduced. The work is performed here on “free” (unbridled) organs, unlike the prior art devices as described above.
The object of the invention is to allow a connection to be made to an anatomical structure under pressure, making it possible to carry out a puncturing or cannulation step without spilling fluid, without having to close up the connection hole by suturing and while exerting as few mechanical constrains as possible on the organ.
Another object of the invention is to be able to close up a tear in a hollow organ, such as an artery, rapidly and lastingly.
Another object of the invention is the manufacturing of a device of such reduced dimensions that it can be used in minimally invasive surgery, i.a. with restricted operation access, via incisions measuring about 10 to 30 mm.